Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve or tube like structure. The procedure permanently reduces the size of the stomach, although there could be some dilatation of the stomach later on in life. The procedure is generally performed laparoscopically and is irreversible.

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Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.[citation needed]

Sleeve gastrectomy is the most commonly performed bariatric surgery worldwide.[1][2] In many cases, sleeve gastrectomy is as effective as gastric bypass surgery, including improvements in glucose homeostasis before substantial weight loss has occurred. This weight-loss independent benefit is related to the decrease in gastric volume, changes in gut peptides, and expression of genes involved in glucose absorption.[3][4]

Sleeve gastrectomy surgery.

The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia.[5] The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 36-40 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.[6]

Endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders[7] and the American Society for Metabolic and Bariatric Surgery,[8] sleeve gastrectomy is gaining popularity in children and adolescents. Studies by Alqahtani and colleagues have found that sleeve gastrectomy causes large weight loss in children and adolescents aged 5 to 21 years.[9] Moreover, they compared weight loss with adults and found comparable weight loss.[10] Recent reports from the group show that growth progresses unaffected after sleeve gastrectomy in children younger than 14 years of age.[11] Although this surgery helps immensely with losing weight the main side effect to this surgery afterwards in the depression that follows the weight loss. This may be because you are realizing that some foods may never be eaten again, or your chemical imbalance is thrown off. It could also be because of the lack of carbohydrates, which throws off the serotonin levels in your body. Another side effect is insomnia. Many people after this surgery can only sleep when they take melatonin or sleeping medications.[12]

There are basically three cost categories for sleeve gastrectomy surgery: pre-operative (all fees associated with preparing the patient for surgery including professional fees, lab work and testing), the surgery itself (including surgeon, surgical assistant, anesthesia and hospital fees) and post-op costs (follow-up physician office visits, vitamins and supplements).[citation needed] Pre-operative costs may include a psychological assessment as required by your physician/surgeon and/or your health insurance carrier.

Out of pocket costs for the sleeve gastrectomy surgery itself may be offered to the patient as a packaged price or charged separately by the surgeon's office, hospital, and other providers. Packaged prices may or may not include pre-op and post-op care, depending on the surgical practice.[citation needed]

Average costs for sleeve gastrectomy surgery are US$19,000 in the United States, although this varies widely between states; South Dakota and Texas offer the lowest average cost at about $12,000 while the most expensive surgeries are performed in Alaska (average about $58,000).In India, it costs between 4-5000US$ for this procedure, all charges inclusive.[16] In Turkey this operation costs $6,000. In Jordan the total cost is around $4,000, which includes all pre-surgery tests, x-ray and hospital fees. In New Zealand the cost is approximately $20,000.[citation needed] In Egypt this surgery costs about $2000–2500. Superannuation in Australia may be accessed by patients to fund the cost of surgery.[17]

In Europe, gastric sleeve surgery is cheaper than in the United States. In eastern countries like Poland, Lithuania and Estonia this surgery costs about $6,000. In the UK a patient pays about $12,600. The most expensive countries are Germany and Italy. Prices of gastric surgery range between $23,500 - $26,200.[18] In Denmark, the typical price is $9,600 dollars as of February 2018 at a private hospital.[citation needed]

The procedure is covered by several insurance plans if deemed medically necessary. Coverage is required in several states in the United States due to requirements of the Affordable Care Act.[19]